<div class="text">
    <label for="amount">
        <?php echo lang('label_wallet_amount') ?>
    </label>
    <samp>
        <input name="amount" id="amount" placeholder="<?php echo lang('label_wallet_amount') ?>" value="<?php echo form_val('amount') ?>" type="text" />
    </samp>
</div>
<div class="text">
    <label for="bank_name">
        <?php echo lang('label_wallet_bank') ?>
    </label>
    <samp>
        <input name="bank_name" id="bank_name" placeholder="<?php echo lang('label_wallet_bank') ?>" value="<?php echo form_val('bank_name') ?>" type="text" />
    </samp>
</div>
<div class="text">
    <label for="sender_name">
        <?php echo lang('label_wallet_sender_name') ?>
    </label>
    <samp>
        <input name="sender_name" id="sender_name" placeholder="<?php echo lang('label_wallet_sender_name') ?>" value="<?php echo form_val('sender_name') ?>" type="text" />
    </samp>

</div>  
<div class="text">
    <label for="account_number">
        <?php echo lang('label_wallet_account_number') ?>
    </label>
    <samp>
        <input name="account_number" id="account_number" placeholder="<?php echo lang('label_wallet_account_number') ?>" value="<?php echo form_val('account_number') ?>" type="text" />
    </samp>

</div> 
<div class="text">
    <label for="note">
        <?php echo lang('label_wallet_note') ?>
    </label>
    <samp>
        <textarea name="note" id="note" placeholder="<?php echo lang('label_wallet_note') ?>" ><?php echo form_val('note') ?></textarea>
    </samp>
</div>